Customs Form 3299 - Declaration Form For Free Entry Of Unaccompanied Articles, Supplemental Declaration For Inaccompaniedpersonal And Household Effects, Customs Form 5291 - Power Of Attorney Page 3
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4Department of the Treasury
U.S. Customs Service
New York Region
New York, N.Y. 10048
SUPPLEMENTAL DECLARATION FOR INACCOMPANIED
PERSONAL AND HOUSEHOLD EFFECTS
1. Owner of Household Goods
(Last Name, First & Middle)
2. Date of Birth
3. Citizenship
4. Passport Information
(Country & Number)
5. Social Security Number
6. Resident Alien Number
7. U.S Address
8. Foreign Address
9. Reason For Moving
10. Employer
11. Position with the Company
12.
Length of Employment
13. Nature of the Business
14. Name and telephone number of a company official who can verify the above information
15. Name and address of freight forwarders, packers and shipping agents
16. Shipment itinerary
(specific place of loading and intermediate ports)
17. Certification
A.
Authorized Agent
B.
Importer
(circle one)
18. Signature
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